The University of Cape Town applied for supplemental funding in order evaluate the use of Community Health Workers (CHW) in screening for CVD in communities located in four countries. The Community Health Workers (CHWs) will use a non-lab based risk assessment tool to identify persons at high risk for Cardiovascular Disease (CVD) in community settings in South Africa, Bangladesh, Guatemala, and Mexico. The risk tool, developed in the US population and tested with good performance in several South African cohorts, uses age, gender, BMI, blood pressure, smoking status, and history of diabetes mellitus (DM) to calculate an absolute risk score for developing CVD. The CHW-generated risk scores will then be compared for agreement to risk scores generated by a trained health professional. If there is significant overlap in the percent agreement between the two sets of scores, it will demonstrate that low-level health workers such as CHWs can be adequately trained to screen for, and identify, those at high risk for CVD. The referral pattern for high-risk patients from CHWs to a trained health professional at a community health clinic will also be assessed. Finally, CHW knowledge levels and retention of knowledge about CVD and its risk factors will be evaluated. This is a collaboration among the COEs in South Africa, Bangladesh, Guatemala and the US-Mexico Border